Key takeaways:
Metoprolol and atenolol are beta blocker medications. Beta blockers can lower blood pressure, but they’re not usually the first-choice treatment for hypertension.
Short-acting metoprolol or atenolol are often prescribed after a heart attack.
Long-acting metoprolol (Metoprolol ER) has proven benefits for certain types of heart failure.
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Metoprolol and atenolol are two of the most commonly prescribed heart medications. Both are a type of medication called beta blockers, which have important benefits for heart health. They can treat chest pain from heart disease and fast or irregular heartbeats. They’re also sometimes used to treat high blood pressure.
But even though they work in similar ways, metoprolol and atenolol have important differences. They aren’t always interchangeable.
What are metoprolol and atenolol used for?
Metoprolol and atenolol are both beta blockers. Beta blockers block some of the effects of adrenaline, a hormone that gets released when your stress response is activated.
Metoprolol and atenolol are known as “selective” beta blockers. That means they act mainly on the heart. They can:
Slow the heart rate
Lower blood pressure
Reduce the work load on the heart
Reduce the heart’s need for oxygen
Relieve chest pain (angina) due to blocked arteries
Help control fast or irregular heart rhythms
Metoprolol comes in two forms:
Immediate release: Metoprolol tartrate (Lopressor)
Extended release (ER): Metoprolol succinate (Toprol XL)
Atenolol (Tenormin) only has one release form.
We’ll go over this in more detail in the sections below
Is metoprolol or atenolol better for hypertension?
Beta blockers aren’t considered first-choice treatment for high blood pressure. That’s because other available medications have fewer side effects. But sometimes a beta blocker is chosen for blood pressure because it can also help a heart condition. The choice usually depends on what other health issues are present.
In the next section, we go over the differences between these medications.
Atenolol vs. metoprolol: Differences at a glance
There are some important differences in the ways that short-acting metoprolol, metoprolol ER, and atenolol work. That includes their uses, dosages, and side effects. The table below provides an overview of these differences before we get into some of the details.
Medication | FDA-approved uses | Usual dosing | Usual adult dose | Side effects |
|---|---|---|---|---|
Atenolol | Hypertension, angina, heart attack care | Once daily | 25 mg to 100 mg once daily | Fatigue, dizziness, slow heart rate, and low blood pressure. Asthma may worsen. Erectile dysfunction may occur. |
Metoprolol ER (metoprolol succinate) | Hypertension, angina, and certain types of heart failure | Once daily | 25 mg to 200 mg once daily | Similar to atenolol. Sleep problems, vivid dreams, and worsening depression are sometimes reported. |
Short-acting metoprolol (metoprolol tartrate) | Hypertension, angina, and heart attack care | Once or twice daily | 25 mg to 100 mg once or twice daily | Similar to metoprolol ER. May cause more fatigue or dizziness immediately after a dose. |
It’s important to know that this chart lists FDA-approved uses. Healthcare professionals sometimes prescribe these medicines for other conditions, like heart rhythm problems.
How do you take metoprolol and atenolol?
Metoprolol tartrate, the immediate-release form of metoprolol, is short acting. That’s why it is usually taken twice daily. The extended-release form of metoprolol can be taken once a day. Atenolol is generally taken once a day. Your healthcare team may recommend a different dosing schedule that works for you.
What are the common side effects of metoprolol and atenolol?
When it comes to side effects, metoprolol and atenolol are similar. Potential side effects include:
Slow heart rate
Shortness of breath
Sleep disturbances
Even though these side effects can happen, most people won’t get them. Some people worry they’ll feel more depressed on beta blockers, but that’s uncommon. An analysis of over 50,000 people found that beta blocker use didn’t increase the risk for depression. But fatigue was more common in people on beta blockers.
If you have diabetes, it’s important to know that both metoprolol and atenolol can cover up symptoms of low blood sugar. These can include heart palpitations, fatigue, and shakiness. This is important because untreated low blood sugar can lead to dangerous complications. If you have diabetes, talk to your healthcare team about how to prevent and spot low blood sugar before you start taking metoprolol or atenolol.
If you have problems with your medication, reach out to your healthcare team. Sometimes, stopping a beta blocker suddenly can cause chest pain or a dangerous spike in blood pressure. In the worst cases, stopping the drug suddenly can even cause a heart attack. That’s why metoprolol and atenolol have important black box warnings about stopping the medications.
How much do metoprolol and atenolol cost?
Metoprolol and atenolol are both available as generic medications. And with a free GoodRx discount, the retail price of the generic versions is less than $10:
Generic metoprolol tartrate’s price is less than $8 with a free GoodRx discount.
Generic metoprolol succinate’s price is less than $10 with a free GoodRx discount.
Generic atenolol’s price is less than $7 with a free GoodRx discount.
If you take multiple medications, consider signing up for GoodRx Companion. You can access discounted prescription medications with a GoodRx Companion subscription. Over 200 medications are available for free, with hundreds more available for under $10.
Frequently asked questions
The best replacement for atenolol depends on the reason you take it, along with your other health conditions. It may also depend on the reason you can’t take atenolol. So, there’s no “one size fits all” answer to this question.
You might switch from atenolol to metoprolol if you have:
Heart failure: Metoprolol ER has proven benefits for this condition. Short-acting metoprolol doesn’t have the same benefits for heart failure.
Lower blood pressure: Short-acting metoprolol can be a better choice than atenolol if your blood pressure tends to get low, since it wears off more quickly.
Kidney disease: Atenolol is removed mainly by the kidneys. So levels of the drug can build up when you have chronic kidney disease. Since metoprolol is broken down mainly by the liver, it can be a better choice in this situation.
Metoprolol tartrate is the short-acting version of metoprolol. Metoprolol succinate (metoprolol ER) is the long-acting form. Both forms of metoprolol can treat chest pain, high blood pressure, or an irregular heartbeat. But metoprolol tartrate is the form that’s used after someone has had a heart attack. Metoprolol succinate is the form that’s used to treat heart failure.
The best replacement for atenolol depends on the reason you take it, along with your other health conditions. It may also depend on the reason you can’t take atenolol. So, there’s no “one size fits all” answer to this question.
You might switch from atenolol to metoprolol if you have:
Heart failure: Metoprolol ER has proven benefits for this condition. Short-acting metoprolol doesn’t have the same benefits for heart failure.
Lower blood pressure: Short-acting metoprolol can be a better choice than atenolol if your blood pressure tends to get low, since it wears off more quickly.
Kidney disease: Atenolol is removed mainly by the kidneys. So levels of the drug can build up when you have chronic kidney disease. Since metoprolol is broken down mainly by the liver, it can be a better choice in this situation.
Metoprolol tartrate is the short-acting version of metoprolol. Metoprolol succinate (metoprolol ER) is the long-acting form. Both forms of metoprolol can treat chest pain, high blood pressure, or an irregular heartbeat. But metoprolol tartrate is the form that’s used after someone has had a heart attack. Metoprolol succinate is the form that’s used to treat heart failure.
The bottom line
Metoprolol tartrate, metoprolol ER (metoprolol succinate), and atenolol are all beta blockers. They can lower blood pressure, prevent chest pain, and control some fast or irregular heartbeats. These drugs work in similar ways and share many of the same side effects.
But they have some important differences. Short-acting metoprolol is usually taken twice a day and may be used during and after a heart attack. Metoprolol ER is taken once a day and can help treat certain types of heart failure. Atenolol is taken once a day. It can also be used following a heart attack, but people with kidney disease may need a lower dose. Your healthcare team can help decide which medication is best for you.
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References
Bornand, D., et al. (2022). β-blockers and the risk of depression: A matched case-control study. Drug Safety.
Farzam, K., et al. (2022). Beta blockers. StatPearls.
Morris, J., et al. (2024). Metoprolol. StatPearls.
Shah, R., et al. (2020). Metoprolol-associated central nervous system complications. Cureus.
Tsujimoto, T., et al. (2017). Risk of cardiovascular events in patients with diabetes mellitus on β-blockers. Hypertension.
